Revelations about MINUSTAH are in the news again. First, a new study published in a U.S. Centers for Disease Control and Prevention (CDC) journal affirms that a MINUSTAH camp was the origin of the cholera outbreak which has killed over 5,500 people so far.

"Our findings strongly suggest that contamination of the Artibonite (river) and 1 of its tributaries downstream from a military camp triggered the epidemic," said the report in the July issue of Emerging Infectious Diseases, a journal of the U.S. Centers for Disease Control and Prevention.

The article says there is "an exact correlation" in time and place between the arrival of a Nepalese battalion from an area of its South Asian homeland that was experiencing a cholera outbreak and the appearance of the first cases in the Meille river a few days later.

The remoteness of the Meille river in central Haiti and the absence of other factors make it unlikely that the cholera strain could have come to Haiti in any other way, the report says.

As we described in detail when suspicions first arose that Nepalese blue helmets had brought the cholera strain to Haiti, MINUSTAH rejected the claims and showed little interest in uncovering the truth about the cause of the epidemic. Cholera, meanwhile, continues to spread, recently increasing with the heavy rains:

The UN Special Envoy for Haiti has released updated numbers on international aid pledges from last March’s donor conference, showing just a minor increase since the last update in early April. Although many donors claimed they were waiting for the new government to take power before releasing aid disbursements, the recent analysis shows that so far at least, little new aid money has been forthcoming from Haiti’s largest donors. In a statement released today, the Special Envoy reported that 37.8 percent ($1.74 billion) of the $4.6 billion in aid pledges had been disbursed through June, up from just 37.2 percent ($1.71 billion) through March. The United States has disbursed just $120 million of the over $900 million appropriated for Haiti, a disbursement rate of just 13.7 percent. This is lower than what had previously been reported.

In an accompanying report, looking at aid to Haiti both before and after the earthquake, Dr. Paul Farmer writes:

After the earthquake, the international community pledged significant financial resources for both the relief and recovery efforts. Yet many of us have been frustrated with the transition between the two phases. Over the past year, donors have disbursed over $1.74 billion for recovery activities, but over half—$2.84 billion—of what was pledged for 2010 and 2011 remains in donors’ hands.

And yet disbursing funds is only part of the aid picture. We know from our shared experiences in Haiti and elsewhere that the way aid is channelled matters a great deal, and determines its impact on the lives of the Haitian people. For example, with over 99 percent of relief funding circumventing Haitian public institutions, the already challenging task of moving from relief to recovery—which requires government leadership, above all—becomes almost impossible.

…

We have heard from the Haitian people time and again that creating jobs and supporting the government to ensure access to basic services are essential to restoring dignity. And we have learned that in order to make progress in these two areas we need to directly invest in Haitian people and their public and private institutions. The Haitian proverb sak vide pa kanpe—“an empty sack cannot stand”—applies here. To revitalize Haitian institutions, we must channel money through them.

As we’ve previously described, State Department cables Wikileaked last year revealed a State offensive against unfavorable media coverage of the U.S. role in the aid effort, with Hillary Clinton instructing all embassies to “push back” against “inaccurate and unfavorable international media coverage of America's role and intentions in Haiti.”

A newly released cable, made available through Wikileaks’ partnership with Haiti Liberté and The Nation, reveals in detail how such “push back” worked, in one case at least.

Diligently following up on Secretary Clinton’s instructions, the U.S. Embassy in Doha, Qatar noticed that “On Sunday, January 17, Al Jazeera's English (AJE) news channel, headquartered in Doha, began running inaccurate coverage of U.S. and international relief efforts in Haiti.” In response, the Embassy took actions resulting in a State Department spokesperson appearing on Aljazeera English in Washington “within hours”; called Aljazeera English Director Tony Burman ahead of another call by Judith A. McHale, Under Secretary of State for Public Diplomacy and Public Affairs, and made sure Burman “understood the serious concerns that the Undersecretary would convey”; and, after said “flakking” took place, monitored Aljazeera coverage, which it noted with satisfaction became “less and less” “inaccurate and confrontational”, “evolv[ing] markedly” “with reporting focused on the work being done by U.S. military forces - particularly airdrops - and 50 orphans who had been sent to the United States on an expedited basis.” The coverage now included more context, the Embassy noted, including regarding logistical obstacles to U.S. efforts at aid distribution.

Heavy rains dumped up to six inches of rain across Port-au-Prince and throughout much of Haiti Monday night. Continued rain is predicted through Thursday. The storms left 23 dead, injured many and left thousands more displaced. A damage assessment by the Département de la protection civile and the IOM found that 32 of 187 camps were flooded and that nearly 500 families were affected in Cite Soleil, one of the worst hit areas. Some camps were under up to four feet of water. The assessment also noted an increase in the number of cases of cholera, and that "latrines have been reported to overflow in some camps."

ActionAid called for better coordination between the U.S. Agency for International Development, the Haitian government and nongovernmental organizations to prevent further disaster this hurricane season. The new devastation, ActionAid said, highlights the need for newly elected President Michel Martelly to immediately implement a long-term housing strategy for Haitians, hundreds of thousands of whom remain under flimsy tents and tarps nearly 17 months after a catastrophic earthquake.

“Disaster mitigation must be prioritized not only in Port-au-Prince, but in vulnerable communities throughout the country that are at risk of severe flooding,’’ Elise Young, an analyst with ActionAid, told The Miami Herald.

This year, although the camp population may be lower than last year, hurricane preparedness is complicated by the high number of people living in damaged housing. Charles reports:

Mellicker said that reality makes “this year much more complex because of the migration patterns to unrepaired homes that are either red or yellow.’’ A home designated as red is one that should be demolished and the yellow label means in need of repair.

A controversial USAID-commissioned report said that 64 percent of red homes have been reoccupied in the Greater Port-au-Prince area.

It is now officially hurricane season. Rains have picked up over the previous weeks and this is already causing a surge in the number of new cholera cases. The most recent data from the MSPP (Ministere de la Sante Publique et da la Population) show that there have been over 320,000 cases, 170,000 hospitalizations and that 5,337 people have died as a result of the disease. In a statement on June 1, the Pan American Health Organization (PAHO) noted that:

During the last days the MSPP and PAHO/WHO have observed an increase in the number of alerts of cholera cases, mainly in the Departments of South-East, Grand-Anse, South, Center and West. New cholera cases have been reported in IDP camps.

Also pointing out that, "due [to] lack of resources numerous NGOs have been withdrawing from these areas and interrupting their water-trucking programs. This situation makes more vulnerable the health of the IDP populations." The Health Cluster vulnerability analysis shows that the West department, because of the high concentration of IDPs, is the most at-risk part of the country. Yesterday, Oxfam reported an increase in cholera cases in the area of Carrefour where, according to the IOM, over 60,000 IDPs are spread between 124 sites. Oxfam public health promoter Mimy Muisa Kambere said:

The current cholera outbreak in the Carrefour area is far worse than the one registered in November. At that time, there were a maximum of 900 reported cases of cholera per week. Now, over 300 new cases are registered every single day. However, the number of casualties is far lower than we saw in November as people are able to get help faster.

To begin with, the report – even if its results are only partially reliable – makes it clear that there are an extremely large number of people living in damaged and dangerous housing. According to the report, many people have returned to housing once slated for destruction, a phenomenon we have written about previously.

As Timothy Schwartz, the lead author of the study, writes:

It means that as many as 570,178 people (114,493 residential groups or families) are living in 84,951 homes that may collapse in foul weather or in the event of another tremor. That’s yellow buildings. For Red buildings it means that 465,996* people (100,430 residential groups) are living in 73,846 buildings that might collapse at any moment. Discussing the growing problem of people returning to unsafe yellow and red buildings, Dr. Miyamoto emphasized the gravity of the situation,

"Occupied yellow and red houses are extremely dangerous since many are a collapse hazard. People occupy these houses despite communications and warnings from MTPTC engineers since they have nowhere to go but the camps. People do not want to stay in these tents. Security is poor and they are exposed to diseases. I see little children sleeping next to the heavily cracked walls every day."

As we previously mentioned, last week the U.S. Government Accountability Office (GAO), the independent government agency tasked with evaluating the performance of the federal government in selected areas, released their assessment of U.S. efforts in Haiti. The report – which bears the less-than-optimistic title “Haiti Reconstruction: U.S. Efforts Have Begun, Expanded Oversight Still to be Implemented” – offers more a description of the general framework of the relief effort than a critical examination of its results to date. For those not aware of where and how hundreds of millions of dollars of federal funding are being channeled in Haiti, the report has a number of useful pie charts, flow charts and bar graphs that provide a clearer picture of where U.S. funds are being spent, and where they aren’t. Although the report offers no examination of whether the programs implemented by the U.S. Agency for International Development (USAID) are actually effective, it does shine a light on some of the structural problems affecting the international relief mission.

The four broad sectors receiving U.S. funding are 1) Infrastructure and Energy (46% of total funds); 2) Governance and Rule of Law (16%); Health and other basic services (13%); and Food and Economic Security (7%). The breakdown of spending within each sector provides evidence of misplaced priorities. For instance, while significant funds are being channeled towards improving Haiti’s energy infrastructure, roads and permanent housing, only a comparatively small amount of allocations are going to rubble removal ($25 million), although the continued presence of rubble throughout Port-au-Prince remains the biggest obstacle to the reconstruction of Haiti’s devastated capital city.

Though the U.S. has allocated over $98 million to health care, only $10 million is being channeled to education (or approximately 1% of total U.S. spending on Haiti’s reconstruction). Haiti’s education sector was in crisis well before the earthquake – with over 60% of students dropping out of school before the sixth grade and the literacy rate hovering around 50%. There are now heaps of rubble where many schools stood and the vast majority of the hundreds of thousands of children in tent camps have no access to any form of education. Given the crucial role that education must play in Haiti’s reconstruction, it’s difficult to understand why this “sub-sector” is receiving so little funding.

The U.S. Government Accountability Office released a report last week noting, among other things, that the Interim Haiti Reconstruction Commission (IHRC) is still not operational, although it still has several months to do so before its mandate ends:

although the commission's mandate ends in October 2011, IHRC is not fully operational due to delays in staffing the commission and defining the role of its Performance and Anticorruption Office--which IHRC officials cited as key to establishing the commission as a model of good governance.

The GAO goes on to note a significant disconnect between what the Haitian government has identified as priorities, and what IHRC has green-lighted:

although the Haitian government identified nearly equal 18-month funding requirements for debris removal and agriculture, IHRC has approved about 7 times more funding for agriculture projects.

The debris removal, of course, is necessary in part to clear space for new shelters, and getting displaced persons out of IDP camps, where cholera – abetted by a severe lack of adequate sanitation – can be a serious danger. (Deutsche Presse-Agentur reported this weekend on a new milestone in post-quake tragedy: 5,200 cholera deaths and 300,000 infections over the past seven months.) Yet just 20 percent of the rubble has been removed, according to various officials. USAID has not made rubble removal much of a priority either, according to the USAID Office of the Inspector General.

An editorial in the New York Times today describes the findings of a UN report that shows the cholera outbreak “may have originated” at a MINUSTAH camp, and says “The fact that the disease is still spreading is a reminder of how much more help Haiti needs and the consequences of continued neglect.”

Even as relief agencies are winding down their presence in Haiti, about 680,000 people are still living in camps and waiting for permanent shelter. Life in this setting is precarious, without adequate access to latrines and safe drinking water.

The United Nations’ overall appeal to respond to the epidemic, for $175 million, is 48 percent financed. Haiti’s continuing health emergency may have been overlooked in a crush of world events, but while the sick and dying are waiting for the world to respond, the disease is not.

The editorial was, unfortunately, all too well-timed, as the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) and the Pan-American Health Organization issued a new warning today of expected "(fresh) outbreaks of cholera in the West, including Port-au-Prince, South and Southeast Departments" accompanying heavy rains and possible flooding.

As we have recently noted, the ongoing cholera epidemic – which now seems to be entering a deadly resurgence, and could kill as many as 11,000 people this year, is closely linked to inadequate sanitation in the IDP camps. This is a theme also addressed in OCHA's warning today: "More water means more cholera and the sanitation in the country is still very weak," Reuters reported OCHA spokesperson Emmanuelle Schneider as saying.

Poor sanitation, a lack of suitable transitional housing, and the poorly funded cholera appeal are all markers of the international community’s failings to come through for the people of Haiti. Now, members of the U.S. Congress are demanding answers. Yesterday, the House passed, by voice vote, bill HR 1016, which, the Miami Herald reports, requires the Obama administration to send to Congress

a report to assess the overall progress of relief, recovery, and reconstruction of Haiti and requires the president to assess within six months the effectiveness of U.S. assistance to Haiti.

…according to the Rep. Frederica Wilson (D – FL), who added an amendment to the bill regarding deportees.

Earlier we reported on an Inspector General report that is extremely critical of USAID/OFDA and their grantees’ efforts in providing housing to displaced Haitians. The audit, however, also raised a separate issue, based on the fact that “USAID/OFDA’s mandate is to save lives, alleviate suffering, and reduce the economic impact of the recent earthquake in Haiti.”

The audit reported that:

As part of the audit, the audit team visited a camp where USAID/OFDA was funding the construction of 800 shelters. There we met a resident who was dying of breast cancer. The woman’s entire right breast was an open wound, and she was suffering great pain. Concerned for the welfare of this person, the audit team alerted grantee officials that the woman needed immediate medical help. The audit team members asked whether the grantee could use their knowledge of local community resources to seek help. However, the auditors were told that many people were sick in Haiti and that helping one person would lead to others asking for help.

The audit team informed USAID/OFDA of the situation, but was told by a USAID/OFDA official in Haiti that USAID could not do anything and that the issue should be taken up with the grantee.